Conception for HIV+ couples
I've idly wondered from time to time how serodiscordant couples maintained a relationship, and how they have children. You see them at the pharmacy, and you know one of them is HIV+ and the other is not, so it does get you thinking. Especially when they have kids.
Wonder no more. Medscape and Viread to the rescue!
All of the couples in the study wanted to have children; the men were already taking antiretrovirals that suppressed their serum HIV below the detectable level.
To further reduce the risk of infection in the female partners, the researchers gave each of them two doses of tenofovir, one to be taken 36 hours before intercourse and another 12 hours before.
After each of the couples had made three attempts, 11 of the 21 couples had conceived, Dr. Vernazza said, and after 10 attempts, 15 were pregnant. These are substantially higher rates than might be expected with artificial reproduction, Vernazza said.
All the women in the study tested negative for HIV, 3 months after the last exposure, the researchers report. "The risk of transmission in a couple with a fully treated male partner is low and can further be reduced by timed intercourse and a short pre-exposure prophylaxis with tenofovir," Dr. Vernazza said.
[...]
"Persuasion of the patients might sometimes be a problem, in which case we still offer them in vitro fertilization (with sperm washing)," he said. "But in general, an hour to explain all the data is enough."
An hour, eh? I wonder if there's a billing code for that?
[tags]HIV, AIDS, conception, tenofovir, Viread[/tags]
Vespula maculifrons can kiss my arse. Err…
This has nothing to do with medicine, and at last count, the F-word is used 22 times in the space of one paragraph. And probably another 22 times outside that paragraph. If that bothers you, go no further.
The "furry harbinger of death"
This is Oscar.
Oscar predicts — with 100% accuracy so far — when people are going to die. The following excerpt is from the NEJM essay mentioned in the AP article, for those who don't have access.
Oscar takes no notice of the woman and leaps up onto the bed. He surveys Mrs. T. She is clearly in the terminal phase of illness, and her breathing is labored. Oscar's examination is interrupted by a nurse, who walks in to ask the daughter whether Mrs. T. is uncomfortable and needs more morphine. The daughter shakes her head, and the nurse retreats. Oscar returns to his work. He sniffs the air, gives Mrs. T. one final look, then jumps off the bed and quickly leaves the room. Not today.
Making his way back up the hallway, Oscar arrives at Room 313. The door is open, and he proceeds inside. Mrs. K. is resting peacefully in her bed, her breathing steady but shallow. She is surrounded by photographs of her grandchildren and one from her wedding day. Despite these keepsakes, she is alone. Oscar jumps onto her bed and again sniffs the air. He pauses to consider the situation, and then turns around twice before curling up beside Mrs. K.
One hour passes. Oscar waits. A nurse walks into the room to check on her patient. She pauses to note Oscar's presence. Concerned, she hurriedly leaves the room and returns to her desk. She grabs Mrs. K.'s chart off the medical-records rack and begins to make phone calls.
Within a half hour the family starts to arrive. Chairs are brought into the room, where the relatives begin their vigil. The priest is called to deliver last rites. And still, Oscar has not budged, instead purring and gently nuzzling Mrs. K. A young grandson asks his mother, "What is the cat doing here?" The mother, fighting back tears, tells him, "He is here to help Grandma get to heaven." Thirty minutes later, Mrs. K. takes her last earthly breath. With this, Oscar sits up, looks around, then departs the room so quietly that the grieving family barely notices.
I think if I were dying, it might be nice to have an animal next to me. Even if I wasn't aware of it. Oscar has a plaque dedicated to him, as well, "For his compassionate hospice care, this plaque is awarded to Oscar the Cat."
Note: Since he was adopted by staff members as a kitten, Oscar the Cat has had an uncanny ability to predict when residents are about to die. Thus far, he has presided over the deaths of more than 25 residents on the third floor of Steere House Nursing and Rehabilitation Center in Providence, Rhode Island. His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families. Oscar has also provided companionship to those who would otherwise have died alone. For his work, he is highly regarded by the physicians and staff at Steere House and by the families of the residents whom he serves.
That's pretty amazing.
And it seems that I Can Has Cheezburger? has made a LOLCAT out of him.
"Hello, my boyfriend is a heroin addict"
"Hello, may I help you?"
"Hello… my boyfriend is a heroin addict."
Not exactly the sort of greeting one expects after picking up the telephone.
"OK."
"Yeah, I was wondering if you could sell him like one needle. I'm worried about him and I don't want him to get AIDS or something like that."
"Um, well, we can't sell you just one syringe. They come in packs of 10. I don't have any way of selling you just one."
"Oh. Really."
"Yeah, I'm sorry."
"Well, how much are they?"
"They're about $2.50 or so for ten."
"Oh. He can't afford that." At this point I'm thinking WHAT THE HELL? You can buy HEROIN but you can't afford $2.50 for some freakin' syringes?!?! Think of it as an investment in the future, FFS!
"Yeah. I'm sorry. I wish I could help you." Where help doesn't necessarily mean "Get you a needle so your SO can shoot up."
"Well… Do you know where I can get him one?"
"Um, you could try a hospital. Maybe they can give you one."
"Oh!" she says brightly. "I'll try that. Thanks!"
*click*
It seems that Massachusetts does not have a clean needle program, and I'm fairly certain that NH doesn't either, since hypodermic needles require a prescription in that state. I guess she really was SOL. I wonder what happened.
Regular readers already know my feelings about selling needles OTC.
The Mass Medical Society doesn't get it
Argue from your Ivory towers all you like. It's meaningless in this day and age. Here's why:
1) If you have an illness that probably falls within the conditions treated by MinuteClinics, and you try to go to your normal doctor, you're probably going to be seen by a midlevel.
2) Medicine is a business, as much as we'd like to pretend that it's not. It is subject to the same economic principles as everything else.
3) Bearing in mind point #2, recall that it is virtually impossible to see your primary care doctor for anything but a visit scheduled months in advance. Until you address that problem, your arguments (no matter how well-reasoned) don't count for much.
4) MinuteClinic has ways of sharing records with doctors. This "continuity of care" argument is nothing but a red herring that sounds nice. All providers have to do is sign up. It is also possible to get referrals from MinuteClinic. (And that's good for YOUR business.)
5) MinuteClinics fill a niche that PCPs are not. That they CANNOT fill using a traditional business model. Change your business model or lose your bread-and-butter: your easy in-and-out patients.
6) MinuteClinics are going to keep more people out of EDs. And that, I think you would agree, is a Good Thing.
Blow smoke all you want. You're not going to stop MinuteClinics from coming. You have two options: embrace them or compete with them. Everything else is meaningless. If you want to stop them, educate your doctors on how to better compete with these health-care-in-a-box places. It's not hard. You've got a built-in advantage. You can monologue if it makes you feel better, but trust me, the public doesn't care. And I don't either.
And while we're at it, let's call this what it is: turf protection. You're trying to protect your turf under the guise of patient care, and there's nothing wrong with that. But railing against it is the wrong way to go about it. You need to be smart: protect your turf using business tactics, not monologues.
But since you're apparently uninterested in doing that, you're going to guarantee that MinuteClinic will gain an easy hold, even in Massachusetts where doctors are a dime a dozen. People WANT to see THEIR doctor. They'd much prefer that over going to see someone they have no relationship with at a Minute Clinic. But until doctors start setting aside time for same-day appointments, en masse, these Minute Clinics are going to thrive.
There's a reason moms like drive-throughs in their pharmacies. Think about that.
I made a mistake the other day
While working in an affluent town the other day — not my normal pharmacy stomping grounds — I was in a pretty good mood. When I'm happy, I get talkative, particularly if I'm somewhat caffeinated, which I was.
Anyway, I rang someone out. Their script was for Imitrex. Since I had done the whole thing from start to finish, I looked at her profile like I always do. (Contrary to popular belief, filling a prescription is NOT a passive activity.) 9×50mg tablets about once every two months. Less than your normal Imitrex user.
She was a nice woman, and (what I assume was) her SO seemed pretty cool, so we were chatting at the register. For some reason, I saw fit to tell this woman that if you take enough Imitrex, your blood will turn green, as it is a bisphosphonate. Useless trivia that I thought was pretty cool. (Cyanosis brought on by sulfhemoglobinemia, where a sulfur atom takes the place of a carbon atom in normal hemoglobin. How green? I don't know, because I've never seen it — though I'd really like to find a picture.)
As soon as I told her, I saw fear come in her eyes, and I knew I had made a mistake. I assured her that this would never happen to her, and that you'd have to be taking huge doses for a long time, but I could see it didn't matter. The damage was done.
Next time I'll just keep my mouth shut about what I think is awesome, and useless. I wince every time I think about the conversation. Why did I have to mention this? Why? It served no purpose.
Errors in judgment can be just as damaging as a "technical" error like dispensing the wrong drug.
Here's to the colorectal surgeon…
Hehehehe…
I promise I'll have something REAL to post Real Soon Now…